Urinary System diseases Flashcards
Name the 5 main roles of the Urinary system
- Filter waste from blood + Excrete it as urine
- Maintain ECF balance
- Balance nutrients (e.g. minerals)
- Produce the hormone Erythropoietin (Stimulating bone marrow to produce RBCs)
- Assists w/regulation of pH + BP
What is Erythropoetin’s most vital role?
To stimulate the bone marrow to create/produce RBCs
What does UUTD stand for?
Upper Urinary Tract Disease
What 2 structures does UURT affect?
- Kidneys
- Ureters
What are the 2 types of UUTD?
- Chronic
- Acute
Give 2 basic Acute examples of UUTD
- Acute Kidney Disease (AKD)
- Acute Renal Failure (ARF)
Give 2 basic Chronic examples of UUTD
- Chronic Kidney Disease (CKD)
- Chronic Renal Failure (CRF)
What breed is the poster breed for Polycystic Kidney Disease (PKD) ?
Persians!
(10)
Name as many aeitologies for UUTD as you can!
- Infection
- Pyelonephritis
- Feline Infectious Peritonitis (FIP)
- Toxaemia
- Nephrotoxins
- Calculi
- Tumors
- Polycystic Kidney Disease (PKD)
- Secondary to Urinary Tract Obstruction (URTO) or other systemtic disease
- Acute on chronic Crisis!
What 2 things does Kidney disease eventually lead to?
Renal insufficiency > Renal failure
What does Renal insufficency mean?
Damaged kidneys that can still process waste, but clinical signs are not yet evident!
What is Renal failure?
- Damage to the kidneys that increases to a point where waste cannot be processed
- 75% of nephrons are damaged
- Clinical signs are apparent
What is the difference between renal insufficiency + renal failure?
- Renal insufficiency is when the kidneys can still function to filter minimal waste, despite the damage + no clinical signs are present
- Whereas Renal failure is the where the irreversible damage has occured in 75% of the nephrons, where clinical signs are apparent
Does the kidney’s ability to concentrate urine decline earlier or later with kidney disease?
Early
What type of maintanance does the kidney perform that becomes affected when renal disfunction is decreased, due to disease?
Ability to maintain fluid + electrolyte homeostasis
Describe what occurs in Renal Functional Adaptation (RRA)
- Renal Functional Adaptation is when the renal tissue begins to lose function and starts to compensate to adapt to the body’s needs
- The remaining non-damaged tissue increases it’s performance (abnormally)
- The loss of 75% of nephrons/renal tissue causes a fall in the Glomeular Filtration Rate (GFR) to 50% of normal
- The plasma concentration of Creatinine + Urea rise as the GFR diminishes, leading to Azotaemia
What is the GFR?
- The Glomerular Filatration Rate
- A test used to estimate how much BP passes through the Glomeruli per minute
Define what is meant by Azotaemia?
An increase of Nitrogenous waste products in the blood stream
What nitrogenous waste products can be found in the blood, with Azotaemia?
- Creatinine
- Urea
What test can indicate the presence of Azotaemia?
BUN
(Blood, Urea, Nitrogen)
What 2 clinical signs may cause Azotaemia in the pre-renal disease stage?
- Dehydration
- Shock
What 2 clinical signs may cause Azotaemia in the Renal disease stage?
- Nephrotoxins
- Glomerulonephritis
What 2 clinical signs may cause Azotaemia in the post-renal disease stage?
- Urinary obstruction
- Trauma
What are the possible aietologies of Acute Kidney Disease/Failure?
- Toxins
- Trauma
- Lower Urinary Obstruction
What happens to the cells + renal blood flow with Acute Kidney Disease/Failure?
- Cellular damage
- Reduced renal blood flow occurs
True or False.
Acute Kidney Disease/Failure does not require emergency treatment + hospilisation.
False!
It’s a vital emergency!
True or False.
AKD or AKF can present with the same clinical signs as Azotaemia.
True!
As Azotaemia is clinical sign that is evident with AKD or AKF.
True or False.
Once the kidneys are no longer able to compensate, the patient will present with signs of KF.
True
What is the most common aetiology for CKD?
Idiopathic deterioration of the geriatric cat!
(8)
Name as many aietologies for CKD as you can
- Idiopathic deterioration
- Previous acute renal damage (Due to injuries or toxins)
- Neoplasia
- PKD
- Chronic infection
- Pyelonephritis
- Glomerulonephritis
- Concurrent conditions (DM, Hypertension)
What is the basic pathophysiology of Renal Failure?
The kidney is simply unable to filter the nitrogenous waste from the blood
What is Uraemia + Why do RKF patients present with this?
- Uraemia is the presence of high levels of Urea in the blood
- Urea is a nitrogenous waste product excreted by the kidneys, normally in the urine. When the kidneys lose their ability to filter these waste products, they build up in the blood, leading to Uraemia
Finish the sentence.
Deterioration of renal function causes p_ + e_________ ________ in RF.
pH + Electrolyte imbalances!
What 2 minerals become imbalanced due to a decrease in renal function?
- Potassium
- Phosphate
What hormone, excreted by the kidney, leads to reduced erthyrocute formation in the bone marrow?
Erythropoietin!
What does ‘reserve capacity of the kidney’ mean?
That the clinical signs of RF only appear when 2/3 - 3/4 of the functioning tissue is lost
What urinary disease presents with the following Clinical signs? …
- Oral ulcers
- Hallitosis
- Depression
- V+
- Inappetance
- Weight loss
- Anorexia
- Seizures
- Anuric (End stage)
- PD/PU
- Dehydration
- Anaemia (If chronic)
CRF!
How is CKD/F diagnosed?
- History
- Clinical signs
- Physical exam
- Urinalysis
- Specific Gravity
- Blood tests
- Blood Pressure
- Radiography
- Ultrasound
NOTE: Important to determine the cause + extent of Azotaemia!
What are the3 most prominent diagnostic tools for diagnosing CKD/F?
- Urinalysis
- SG
- Bloods
What blood tests should be performed when diagnosing CKD/F?
- BUN
- Look for elevated levels or Urea + Creatinine in the plasma!
When looking are Urea + Creatinine levels in the plasma, for diagnosing CKD/F, what may rise first?
Creatinine
What diagnostic tests should be performed that is more sensitive to early changes of CKD/, alongside the Creatinine IRIS staging?
SDMA testing!
(Symmetric Dimethylarginine)
What is SDMA testing + why is it important for diagnosing CKD/F?
- SDMA (Symmetric Dimethylarginin) is an AA produced by the body when protein is broken down + excreted in the kidneys.
- Sensitive biomarker of kidney function + can detect kidney issues as early as 25% loss of kidney function
Why should you check electrolyte levels when diagnosing CKD/F?
Because phosphate levels increase with CKD + may be used to detect Hypokalaemia
What USG figure is representative of CKD/F in Cats?
< 1.035
What does USG identify in CKD/F?
To identify the loss of concentrating ability of the kidneys
True or False.
Increasing USG raises suspicion + often another early sign of CKD/F.
False, declining USG would! As the kidney’s ability to concentrate is imparied.
True or False.
Urine Protein levels will increase if kidney function is imparied.
True
What 2 things should be ruled out when diagnosing CKD/F?
- Presence of blood in urine
- Signs of infection
What establishment is known to develop staging for CKD/F?
IRIS
(9)
How is CKD/F treated?
Name as many treatments as you can.
- IVFT
- Diet management - phosphate restriction
- Drugs (ie. Antibiotics)
- Phosphate binders
- Potassium supplementation
- Managing hypertension (Amlodipine)
- Treat anaemia (Nandralone, Erythropoietin)
- Monitor urine infections
- Manage anorexia + V+
Ethical dilemma - should we offer Kidney transplants in Cats?
No.
This is because CKF or AKF occurs when there is a loss of 75% of renal tissue, if 50% is taken and given to another, the donor is almost garaunteed to end up in the same situation as the recipient!
What does LUTD stand for?
Lower Urinary Tract Disease
What 2 main structures does LUTD affect?
- Bladder
- Urethra
(8)
Name as many possible aetiologies as you can for LUTD.
- Infection
- Calculi/Crystals
- Neoplasia
- Trauma
- Iatrogenic
- Neurogenic
- Concurrent diseases (i.e, DM)
- Idiopathic
What is the most common aetiology of LUTD?
Idiopathic!
(16)
Name as many clinical signs of LUTD as you can.
- Cystitis
- Pollakuria
- Dysuria
- Haematuria
- Pain
- Blockage
- Oliguria
- Anuria
- Incontinence
- Varying frequency/volume of urine
- Abnormal micturition (weak or interrupted)
- Licking external genitalia
- Depression
- V+
- Anorexia
- Dehydration
What possible urinary disease may present with these clinical signs?
* Blockage
* Licking external genitalia
* Abnormal micturition
* Cystitis
* Oliguria
* Anuria
* Depression
* V+
* Incontinence
* Haematuria
LUTD
What LUTD is common in Cats?
Feline Lower Urinary Tract Disease
(FLUTD)
What LUTD has a multifactorial in Cats?
FLUTD
What is the most common aetiology of FLUTD?
Idiopathic Cystitis!
(8)
Names as many aetiologies for FLUTD as you can.
- Idiopathic Cystitis
- Urolithiasis
- Crystals (Urethral plug)
- Infection - rare
- Stress of living in a Multi-cat household
- Underactive lifestyle
- Overweight
- Neutuering
Why may bladder palpation be painful in a cat with FLUTD?
Because the urethra may be/is blocked!
What does FIC stand for?
Feline Idiopathic Cystitis
What is FIC + how can it cause FLUTD?
- FIC = Feline Idiopathic Cystitis
- Because there is irritation or inflammation of the bladder wall/urethra
What can cause recurrent bouts of Cystitis?
FIC + FLUTD
What 2 things can cause a urinary obstruction, leading to FLUTD?
- Uroliths
- Urethral plugs
True or False.
Urotliths or Urethral plugs in the FLUT is not deemed an emergency.
False - it is!
Always be wary of a blocked cat, especially males!
As this will lead to Azotaemia + clinical signs of ARF!
ARF = Acute Renal Failure
1 is very dangerous!!
What can trauma or Iatrogenic damage result in with FLUTD?
Bladder wall dysfunction or rupture of the urinary tract!
What does ARF mean?
Acute Renal Failure
What 2 dangerous things does inability to void urine lead to?
- Azotaemia
- ARF
Name 4 urinary crystals that can be found in FLUTD
- Struvite
- Calcium oxalate
- Cystine
- Ammonium urate
Name this urinary crystal
Struvite
Name this urinary crystal
Calcium oxalate
Name this urinary crystal
Cystine
Name this urinary crystal
Ammonium urate
Name the 3 most important diagnostic tools used to diagnose FLUTD
- Urinalysis
- Radiography
- Ultrasound
(9)
Name as many diagnostic tools used to diagnose FLUTD as you can
- History
- Clinical signs
- Physical exam
- Observation of micturition
- Neurological examination - where indicated
- Urinalysis - visual appearence, dipstick, microscopy, culture + USG
- Ultrasound
- Haematology
- Biochemistry
(13)
Name as many treatment options for FLUTD as you can.
- Treat cause
- Clear blockages
- Empty bladder
- Catherisation
- Sterile saline
- Cystocentesis
- Increase water intake
- Resolve any toileting problems (i.e. Litter trays)
- Antibiotics
- NSAIDS
- Analgesia - if indicated for pain
- Diet management + modification
- Pheromone treatment
What occurs in PKD?
Normal kidney tissue is gradually replaced by multiple fluid filled cysts
What infections occur with CKD?
Bacterial infections - otherwise known as Pyelonephritis
Name an example of a kidney tumour that may cause CKD
Lymphoma
What is Lymphoma?
A solid tumour of the WBCs
What is meant by Glomerulonephritis?
Inflammation of the glomeruli (the individual units within the kidney that filter the blood) + may become inflamed for various reasons - if prolonged - lead to CKD
True or False.
Hypercalcaemia may cause CKD, but studies are still ongoing..
True
What age do Cats commonly present with CKD?
Middle - old age
or
Over 7 y/o
What percentage of Cats are estimated to have CKD over 15 y/o?
15-20%
True or False.
CKD is 5x more common in Cats than Dogs.
False.
It’s 3x more likely!
True or False.
ACE inhibitors cannot be used with Cats with CKD.
False.
Blocking the activation of the hormone, Angiotensin, with ACE inhibitors such as Benazepril or Enalapril or ARBs (Angiotensin Receptor Blockers), such as Telmisartan act as vasodilators to:
* Increase blood flow through the kidneys
* Help lower BP
* Reduce protein loss
What 2 sections are FLUTD subdivided into?
- Obstructive
- Non-obstructive
